LETTER TO THE EDITOR

Cultural humility: treating the patient, not the illness

P atient populations across the world are becoming

increasingly diverse, introducing a variety of health

behaviours that are influenced by a patient’s cultural

background. Tomorrow’s Doctors guidelines state that all

qualified doctors must respect patients ‘without prejudice’,

irrespective of ‘diversity of background and opportunity,

language, culture and way of life’ (1). Are medical students

currently being fully supported to acquire this fundamen-

tal skill?

A suggested definition of culturally competent care

assumes that healthcare providers can ‘learn a quantifiable

set of attitudes and communication skills’ that will allow

them to work effectively within the cultural context of

the patients they come across (2). However, the broad

nature of cultural competency limits its integration into

an already intense medical curriculum (3). So, how can

developments in medical education overcome this chal-

lenge? It can be done by promoting cultural humility.

In the medical context, cultural humility may be defined

as a process of being aware of how people’s culture

can impact their health behaviours and in turn using this

awareness to cultivate sensitive approaches in treating

patients (4).

Unlike cultural competency, there is no specific end

point to cultural humility as we are not being asked to

demonstrate a ‘quantifiable set of attitudes’. This concept

is a continual process, one that requires self-reflection and

self-critique. Developing cultural humility in itself is a

prerequisite to cultural competency. It does so by forming

a foundation for students to consider possible power

imbalances that may arise between a doctor and patient

when cultural differences may have an impact on the poten-

tial clinical outcome for the patient. Subsequently, the

student may be encouraged to develop approaches and skills

that could contribute to a harmonious dynamic of the

doctor?patient relationship (5). Patient care is individua- lised as we take time to consider a patient’s personal beliefs

rather than attempting to place them under a cultural label.

Developing cultural humility will therefore allow students

to appreciate someone’s culture as a dynamic entity.

Drawing upon the philosophy of Daoism, which is

based on the concept of humility leading to the attain-

ment of knowledge, Chang et al. argue that cultural

humility can greatly increase the student’s receptiveness to

learn about their own attitudes (5). Chang et al. further

describes the concept o